Outcomes of burns patients in a developing country: A single centre’s experience

Abstract

Background. Pelonomi Tertiary Hospital is the only hospital in the Free State Province with a burns unit. We do not have official data to assess our performance in the management of burns. Objective. To determine the Lethal Area 50 (LA50) index for the Pelonomi Tertiary Hospital’s burns unit. Furthermore, to determine the morbidity that affects burns patients at the institution, and the factors associated with outcomes. Methods. We used Redcap to capture demographic and clinical data of burn patients admitted to our institution between January 2014 and December 2018. Logistic regression was used to determine significant predictors of the outcomes. The LA50 was calculated by performing a probit regression of survival by total body surface area (TBSA). We used SAS 9.4 statistics software package.Results. Our study had a male preponderance, with 59.7% (601) male, 39.9% (401) female and 0.4% (4) missing sex. We had a mean age of 19.4 years, of which 53.38% (n=537) were paediatric patients and 46.32% (n=469) adults. The mean length of hospital stay was 16.88 days. Our LA50 was 37%, and the overall mortality was 14.63%, with a mean age of 33.96, a mean TBSA of 43.3% and a mean revised Baux score of 80.55 for the mortality group. The paediatric group had a 5.03% (n=27) mortality rate, with 88.88% of these being children under 5 years with an LA50 of 45%, and the adult group had a 25.56% (n=120) mortality rate with an LA50 of 34%. Factors associated with mortality were age (p<0.0001), TBSA (p<0.0001), female sex (p=0.4126), full-thickness burns (p=0.7160) and burns to the head (p=0.9038). The leading cause of injury was hot water (46.5% of patients), followed by fire at 38.6%. HIV was the leading comorbidity, affecting 6.9% (n=67) of patients, followed by hypertension at 4.67% (n=47), and 2.58% (n=26) of patients had epilepsy. The leading complication was sepsis, affecting 14.67% (n=144) of patients. The average waiting time between admission and skin graft was 25.29 days, and for debridement was 3.57 days. Conclusion. The epidemiology of burn patients and working conditions at Pelonomi Tertiary Hospital are similar to other burn units in the country; however, our mortality rate is higher than at most centres. The LA50 is low, but in keeping with the rest of Africa, and our predictors of mortality are in keeping with those found in other studies in other parts of the world.